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Approach to Liver Function Test

Dr Yasir M Khayyat,MBcHB,FRCPC,FACP. Approach to Liver Function Test. Before you order LFT ask. 600 ريال. Hepatocellular Necrosis Markers. Markers of synthetic function. INR. Markers of Cholestasis. Liver cell. Liver cell. AST ALT. ALT: Specific from the liver ,Cytosolic Enzyme

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Approach to Liver Function Test

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  1. Khayyat Y Dr Yasir M Khayyat,MBcHB,FRCPC,FACP Approach to Liver Function Test

  2. Khayyat Y Before you order LFT ask 600 ريال

  3. Khayyat Y Hepatocellular Necrosis Markers Markers of synthetic function INR Markers of Cholestasis

  4. Khayyat Y Liver cell

  5. Khayyat Y Liver cell AST ALT

  6. ALT: • Specific from the liver ,Cytosolic Enzyme AST: • Muscle(skeletal , Cardiac),Brain,Kidney,Pancreas, cytoslic 20% and mitochondrial 80%. • Levels are normal in advanced cirrhosis AST/ALT ratio : • Acute liver injury ≤ 1 , Alcoholic hepatitis > 2 • Its elevation does not correlate with hepatic necrosis. Khayyat Y

  7. In Alcoholic liver disease AST  Alcohol increase release of mitochondrial AST ALT in alcohol there is pyridoxal 5 deficiency with decrease in ALT > AST activity In NAFLD,chronic liver disease: AST ( early low ,then with progressive disease and cirrhosis increase) , advanced cirrhosis  decrease hepatic clearance of AST. ALT Khayyat Y

  8. Alkaline phosphatase: • From Liver,Bone,Kidney,placenta,leukocytes,various neoplasms. • From the apical membrane of the hepatocyte and luminal domain of the bile duct. • Predominantly in infiltrative hepatic disorders, biliary obstruction ,extrahepatic biliary tree obstruction. • Due to increased de novo synthesis rather than release of the stored enzyme or impaired clearance GGT ( Gamma Glutamyl Transpeptidase) • From kidney,spleen,pancreas,heart,lung,brain Khayyat Y

  9. Bilirubin • Conjugated Bilirubin • Unconjugated Bilirubin Markers of Hepatic Synthesis: • INR or PT : • The liver is factory for all coagulation factors except 8. • INR if dependant on Vit K ( 2,7,9,10) • Increased in: vitamin K deficiency( malnutrition-malabsorption-antibiotic use)warfarin use, consumptive coagulpathy. Khayyat Y

  10. Albumin : • Synthesize 10g by the liver daily. It is not only reflect liver status but it reflects nutritional and volume status, vascular integrity,catabolism,hormonal factors, loss in the urine or stool. Khayyat Y

  11. Khayyat Y Non Hepatic causes of abnormal lft:

  12. Khayyat Y Hepatocellular necrosis

  13. Khayyat Y Cholestasis

  14. Khayyat Y

  15. Khayyat Y Hepatic granulomas

  16. Khayyat Y Think about the causes of liver disesase

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